| NPI | 1306004247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 100158) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036126470) |
| Enumeration Date | 2008-05-28 |
| Last Update Date | 2023-02-09 |